Social work and clinical practice have changed dramatically over the past decade, contributing to additional stress and risk to the clinician.  Each year clinicians find themselves more vulnerable in practice from a clinicial and legal perspective.  Agencies and small practice administrative positions that provided clinicial support are either eliminated or reduced.  Combine this fact with large and complex caseloads and a high risk situation is created for a clinician to meet required agency and legal responsibilities.  Clinicians who are branching out into private practice face similar isolation and risk.  Distracted by complicated and costly business and legal requirements, sole proprietors find themselves further isolating themselves by reducing clinical support, thereby exposing themselves to legal risk as well.   It is critical that clinicians continue to recognize trends occuring in society that affect their practice, and initiate the process to meet these challenges.

Clinicial consultation is interwoven into the very fabric of an ethical and legal practice.  The most effective methods for support consistently include both decreasing the isolation of workers, as well as increasing the utilization of clinical consultation.  It is essential that clinicians are proactive in being creative and conscience about tailoring a service of support that meets their clinical, financial, and personal needs.

Clinicial consultation is defined in this discussion as a clinician driven service to explore and create solution focused options.  Experience, knowledge, and a clinician's personal reaction to certain situations that present themselves in practice, determine the type and frequency of clinicial consultation.  Clinicians who utilize opportunities to increase their education and training, and seek consistent and proper clinicial support are positioned to legally protect and enhance their service delivery.

Reflectivity is a necessity to ensure ethical and objective care is provided.  A clinician must be willing and able to explore their own prejudges and biases.  They must also be willing to examine their own challenges in the context of intervention and service.  Clinicial consultation provides a safe and productive environment to analyze the above areas and create or further develop skills to achieve ehtical delivery of service.

Therefore, the question is not "to consult or not to consult".  It is how to utilize clinicial consultative service to enhance your own individual professional growth, and to limit or mitigate legal risks for your practice that accompany such complex work.

Three primary typles of clinical consultation provided are individual consultation, group consultation, and telephone consultation.  Further exploration of these service types will enable you to maximize this support service.

Individual Consultation provides an opportunity to hone specific skills and focus in-depth on self-awareness regarding a particular area of interest or specialty practice area.  To maximize individual sessions, it's beneficial to be forthcoming about strengths and challenges as a clinician, or to identify undefined areas.  This service is ideal for the clinician who desires analyzing a client or case in more detail to cover all aspects of care.  This is also an excellent option for those clinicians who seek to clarify or enhance a specific area of theory, or for those who want to examine the content of a situation in practice and their own reactant level in that context.  Those who work through the vulnerablility of the "heightened self-awareness" process, continue to gain greater insight as to the therapist-client dynamic.  This creates greater opportunity to maintain boundaries, remain client-focused, and apply effective methods for change.

Group Consultation typically consists of colleagues that have different training and theoretical background.  Group provides an opportunity to acquire new methods and techniques by exchanging ideas with other colleagues.  This is a stimulating environment that allows different options to be examined, and provides preventative measures by exploration of collegial experience.  To maximize group sessions, members benefit the most by taking an active role in establishing norms and expectations, and actively participating in the exchange.  This is an ideal situation for those clinicians who feel isolated in the field, or who would like a broader perspective of the profession that what is experienced in their personal practice.  This is an excellent option for clinicians who are seeking an opportunity to experience a group process and enhance skills in presenting and examining cases in a different context.  Those who work through the vulnerability of the group experience gain confidence as a clinician, and greater insight into client perspective.  Group is also a bounteous resource and referral venue.

Telephone Consultation provides an opportunity to review a treatment plan or review a safey plan established, and assist with guidance in a crisis situation.  This is an additional legal and clinical measure taken by a clinician to ensure all required and applicable care was delivered for the safety of a client until the next follow up service is delivered.  This also allows an opportunity for review of structured options of intervention that prevent or decrease the crisis moments, creating an opportunity for change through a consistent and stable treatment plan.  To maximize telephone consultation, be clear and consise regarding your concerns, and what assistance or guidance you are seeking.  This option is recommended for any high risk situation to ensure safety for the client, and to limit liability and negligent risks for the clinician.

Consistent clinical consultation is necessary in providing effectice social work and clinical intervention in society today.  There are numerous dynamics occuring with each intervention and service, as well as multiple clinical, legal, and ethical predicaments facing a clinician.  By receiving proper support and guidance to navigate the clinical and legal practice risks, this allows a clinician to create a strong foundation of service, while developing effective and innovative treatment methods.

Many clinicians have found creative ways to initiate and establish clinicial support service in their own organization and practice.  A sample of ideas is as follows:

• Speak to your agency or small business practice about contracting with a clinical consultant to assess and develop a supportive clinical system tailored to the professional and personal needs of the staff
• Obtain an assessment from a clinicial consultant to assist in tailoring a specific support system to meet your professional and personal needs.
• Speak to your agency or small business practice about contracting with a clinical consultant if the agency is unable to afford a position.  This does not require a committed salary, and does not require the benefits of insurance or additional business expenditures.  If they are unable or unwilling to fund the entire financial cost, inquire about the agency contributing to a portion of the cost.
• Speak to your colleagues about contracting for group consultation from a clinicial consultant.  Group consultation is often more cost effective and addresses bout the clinical need and the isolation need.
• Speak to colleagues about contracting with a clinicial consultant for individual consultation.  Clinical consultants may be willing to offer a discount price if they are speaking to several clinicians as opposed to one.